Abstract
Malnutrition is highly prevalent in patients with heart failure (HF), but the precise impact of dietary energy deficiency on HF patients’ clinical outcomes is not known. We investigated the associations between inadequate calorie intake and adverse clinical events in 145 stable outpatients with chronic HF who had a history of hospitalization due to worsening HF. To assess the patients’ dietary pattern, we used a brief self-administered diet-history questionnaire (BDHQ). Inadequate calorie intake was defined as <60% of the estimated energy requirement. In the total chronic HF cohort, the median calorie intake was 1628 kcal/day. Forty-four patients (30%) were identified as having an inadequate calorie intake. A Kaplan–Meier analysis revealed that the patients with inadequate calorie intake had significantly worse clinical outcomes including all-cause death and HF-related hospitalization during the 1-year follow-up period versus those with adequate calorie intake (20% vs. 5%, p < 0.01). A multivariate logistic regression analysis showed that inadequate calorie intake was an independent predictor of adverse clinical events after adjustment for various factors that may influence patients’ calorie intake. Among patients with chronic HF, inadequate calorie intake was associated with an increased risk of all-cause mortality and rehospitalization due to worsening HF. However, our results are preliminary and larger studies with direct measurements of dietary calorie intake and total energy expenditure are needed to clarify the intrinsic nature of this relationship.
Highlights
Heart failure (HF) is common in adults and is associated with increased morbidity and mortality
The median age of the chronic heart failure (HF) patients with inadequate calorie intake was younger than that of the patients with adequate calorie intake, but there was no significant difference in body mass index (BMI) or muscle mass between the groups
odds ratios (ORs): odds ratio; confidence intervals (CIs): As confounding confidence interval.factors that may influence patient’s dietary calorie intake, age, BMI, NYHA functional class III, diabetes, left ventricular ejection fraction (LVEF), serum albumin, estimated glomerular filtration rate (eGFR), and log B-type natriuretic peptide (BNP) were included in each analysis
Summary
Heart failure (HF) is common in adults and is associated with increased morbidity and mortality. Malnutrition is highly prevalent in patients with chronic HF, and it increases their risk of death and hospitalization [4]. Patients with chronic HF have been demonstrated to have an increased energy expenditure compared to healthy sedentary subjects, but HF patients’ dietary energy intake is often insufficient to meet their energy requirements for daily activities, even in a stable condition [5]. Restrictive diets for HF patients may cause a reduced intake of macronutrients and micronutrients, leading to increased morbidity and mortality [8]. We conducted the present study to determine whether calorie intake that is inadequate for the energy needed for daily activities is associated with adverse clinical events including all-cause death and HF-related hospitalization in stable patients with chronic HF. The patients’ daily calorie intake was calculated by a brief self-administered diet-history questionnaire (BDHQ), which is a well-validated questionnaire for determining a patient’s dietary pattern
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